Complications
Various neurologic deficits may result from the hematoma or its sequelae, including increased intracranial pressure. Recovery is of variable degree and time course.[3]
Coma can result from the head injury itself or from treatment of subdural hematoma.[3]
Large-volume subdural hematoma (SDHs) with significant midline shift or brain swelling after their removal may result in direct compression of anterior and posterior cerebral arteries, causing ischemia and/or infarction. SDHs that occur in association with significant subarachnoid hemorrhage may result in stroke from vasospasm. An increased risk of ischemic stroke, in the 4 weeks after nontraumatic SDH, may be due to interruption of antithrombotic therapy after SDH diagnosis.[186]
Infection rates have been quoted to be 1% to 2%.[191]
Patients with trauma-induced and nontrauma-related subdural hematoma (SDH) are at increased risk of seizures.[133] Up to 24% of patients with traumatic SDHs develop clinical seizures or epileptiform changes on electroencephalography either on presentation or postoperatively.[192] If the patient has seizures within the first week and has a severe brain injury, the likelihood is higher that they will have seizures beyond the first week. It is recommended that the patient continue receiving an anticonvulsant for at least 7 days after injury.[142][193][194]
Occurrence of seizures after this time frame may necessitate further anticonvulsant treatment and/or consultation with a neurologist.
Blood can reaccumulate in the subdural space acutely after an evacuation procedure or may appear in a delayed fashion, presenting as a subacute or chronic SDH.
Meticulous attention must be paid to correcting any preexisting or postoperative coagulopathy.[195] Frontal drainage after burr hole craniotomy has been shown to reduce risk of recurrence without increasing the risk of infection.[196]
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